Mass Forming Eosinophilic Cystitis in Pediatric Patients

Zhou, Alice; Amin, Ali; Yates, Jennifer; Diamond, David A.; Tyminski, Monique M.; Badway, Joseph; Ellsworth, Pamela; Aidlen, Jeremy T.; Owens, Christopher L.

doi:10.1016/j.urology.2016.11.002

Cited by 16 publications

(15 citation statements)

References 8 publications

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“…The bladder wall may have a markedly hyperemic appearance at color Doppler US (Fig 14a), and there may be clinical signs of macroscopic hematuria. The urine is usually sterile, and there may be a history of atopy (85). The masslike appearance with this condition is thought to be due to an antigenic stimulus that promotes the immunoglobulin E-mediated attraction of eosinophils throughout the bladder wall, with subsequent mass cell degranulation and releasing of inflammatory mediators (86).…”

Section: Inflammatory or Nonneoplastic Lesion Misinterpreted As A Tumormentioning

confidence: 99%

Pearls and Pitfalls in Diagnosing Pediatric Urinary Bladder Masses

et al. 2017

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Urinary bladder masses are rare in children, and the associated histologic features and prognoses in this population are different from those in adults. Most children with urinary bladder masses present with lower urinary tract symptoms, which may include hematuria, dysuria, frequent urination, and urgency to urinate. However, some of these masses may be identified incidentally or involve generic symptoms such as abdominal distention. In general, pediatric bladder tumors can be divided into those that originate from the bladder epithelium, known as urothelial neoplasms, and mesenchymal bladder neoplasms, which are more prevalent. The most common bladder malignancy in children is a rhabdomyosarcoma, whereas the most common benign bladder lesion in the pediatric population is a papillary urothelial neoplasm of low malignant potential (PUNLMP). The first-line imaging tool for assessing bladder lesions is ultrasonography, which may be followed by a cross-sectional imaging examination such as computed tomography or magnetic resonance imaging if the origin of the mass is unclear or if distant spread is suspected. Although imaging may enable the radiologist to suggest a differential diagnosis based on lesion location and patient age, tissue biopsy generally is required to identify the exact pathologic entity. This is usually performed at cystoscopy and may be curative in cases in which the lesion is small and has low recurrence potential. Knowledge of the clinical, histopathologic, and imaging features of common bladder neoplasms is essential, as it can aid in preventing imaging pitfalls. These may include the misinterpretation of either a pelvic mass as arising from the bladder or a bladder mass as arising from the pelvis, and interpreting an inflammatory mass or bladder detritus as a neoplasm. RSNA, 2017.

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Section: Inflammatory or Nonneoplastic Lesion Misinterpreted As A Tumormentioning

confidence: 99%

Pearls and Pitfalls in Diagnosing Pediatric Urinary Bladder Masses

et al. 2017

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“…Adult patients with EC may present with a variety of urinary symptoms, including frequent urination, urgent urination, odynuria, hematuria, dysuria and suprapubic pain; children with EC often have similar symptoms ( 9 , 10 ). Pathologic biopsy findings are therefore paramount for differential diagnosis ( 11 ). Treatments for EC include observation, identification of allergens, antibiotics, antihistamines and steroids ( 12 ).…”

Section: Introductionmentioning

confidence: 99%

Eosinophilic cystitis in children: A case report

Ning

et al. 2018

Exp Ther Med

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The aim of the present case report was to investigate the clinical features, pathological examination and treatment of eosinophilic cystitis (EC) in children. Two cases of EC were reported and reviewed from January 2016 to March 2017. Case 1 (male; 6 years old) had intermittent hematuria, frequent urination, urgent urination, difficulty in urination and abdominal pain. Case 2 (male; 7 years old) had frequent urination, urgent urination, urinary pain, dysuria and suprapubic pain with no hematuria. One patient had a history of allergies and both patients underwent a cystoscope biopsy. Blood eosinophils were clearly increased and a bone marrow biopsy examination revealed that marrow eosinophils were also increased in both cases. The urine culture results were negative. Ultrasonography and computed tomography revealed uneven thickening of the bladder wall and diffusive mucosal lesions. Cystoscopy revealed that the bladder volume became smaller and the mucosa at the bladder floor and neck was red. Lesions were biopsied through the urethra and the following characteristics were observed: Congestion and edema of the bladder mucosa, infiltration of the blood vessels and eosinophils in the muscular layer, accompanied by focal muscle necrosis. Patient 1 was administered anti-inflammatory and cetirizine hydrochloride treatments, followed by 6 weeks of prednisone dose-reduction therapy. Patient 2 was administered antibiotics and cetirizine hydrochloride. Following 6-month follow-ups, abnormal voiding symptoms had disappeared in each case. Ultrasonography and computed tomography revealed no bladder wall thickening or space-occupying lesions. EC in children is rare and easily misdiagnosed as nonspecific bladder inflammation or bladder occupying lesions. Cystoscopy and biopsy are necessary to diagnose EC and conservative treatments with anti-inflammatory, anti-allergic and cortical hormone nonspecific treatments are suggested.

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“…The diagnosis of EC can be made when many eosinophils are visible in bladder specimens [ 1 , 2 , 4 , 6 , 7 ]. There are no definite pathologic criteria for EC, but more than 25 eosinophils per high power field of view can be thought of as indicating EC, similar to eosinophilic esophagitis and gastritis [ 13 ]. In our case, heavy infiltration of eosinophils was visible around the mucosa and vessels in the lamina propria and muscularis propria, therefore diagnosis of EC could be made.…”

Section: Discussionmentioning

confidence: 99%

A rare case of eosinophilic cystitis involving the inside and outside of the urinary bladder associated with an infected urachal cyst

et al. 2021

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Background Eosinophilic cystitis is a rare inflammatory disease of the bladder characterized by eosinophilic infiltration of the bladder wall. Most Eosinophilic cystitis cases present with mucosal lesions of the urinary bladder. We present a very rare case of large mass-forming eosinophilic cystitis, involving the inside and outside of the bladder associated with an infected urachal cyst. Case presentation A 59-year-old man presented with gross hematuria, fever, dysuria, and suprapubic pain. Computed tomography showed a heterogeneously enhancing mass that measured 7.6 cm × 4 cm located on the anterosuperior portion of the bladder with an internal fluid collection. Cystoscopy revealed a raspberry-like mass lesion on the bladder dome. Transurethral resection of the bladder was initially performed. The mass lesion protruding from inside the bladder was removed, and pus-like fluid was drained. The pathologic diagnosis was eosinophilic cystitis. Follow-up computed tomography showed a remnant mass outside the bladder and urachal cyst. To eliminate the remnant lesion, robot-assisted partial cystectomy was performed. The patient showed no evidence of recurrent disease on follow-up cystoscopy and computed tomography for up to 2 years. Conclusions Clinicians should consider the possibility of eosinophilic cystitis in patients who present with hematuria, fever, and suprapubic pain and have both intravesical and extravesical masses.

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Mass Forming Eosinophilic Cystitis in Pediatric Patients

Cited by 16 publications

References 8 publications

Pearls and Pitfalls in Diagnosing Pediatric Urinary Bladder Masses

Pearls and Pitfalls in Diagnosing Pediatric Urinary Bladder Masses

Eosinophilic cystitis in children: A case report

A rare case of eosinophilic cystitis involving the inside and outside of the urinary bladder associated with an infected urachal cyst

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